Faculty:

Disclosure of Conflicts of Interest

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Method of Participation and Request for Credit

Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2019, participants must read the learning objectives and faculty disclosures and study the educational activity.

If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.

For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.

Joint Accreditation Statement

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education

Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.

Epithelial ovarian cancer is generally detected late, with overall five year survival of 20-30%. The search for a cheap, accurate screening test to identify the disease in its early stage has been ongoing for the past few decades. Currently, there is no proven strategy for the early detection of cancer that decreases ovarian cancer mortality.

In the most recent Committee Opinion, ACOG makes the following statement regarding direct-to-consumer marketing of ovarian cancer screening tests

At this time, there is insufficient evidence to support the use of any of these tests or algorithms for the early detection of ovarian cancer in average-risk women. Women considering purchasing these tests, which are currently not approved nor cleared by the U.S. Food and Drug Administration for ovarian cancer screening and are not financially covered by medical insurance, should be counseled on the risks of such tests.

CLINICAL ACTIONS:

Low risk, asymptomatic women:

Do not use transvaginal ultrasound and tumor markers for ovarian cancer screening

These tests are ineffective, lacking good sensitivity, specificity, and positive predictive value

High risk women, including those with a BRCA mutation or a positive family history:

Refer for genetic counseling

Screen with CA-125 and transvaginal ultrasound every 6 months

Offer risk reducing bilateral salpingo-oophorectomy by age 40 if they carry a known disease causing mutation in BRCA1 or BRCA2

Women who are symptomatic and present with abdominal symptoms:

Physical and pelvic exam

Rectovaginal exam

Transvaginal ultrasound

Postmenopausal women with a pelvic mass, in addition to the above (physical, pelvic, rectovaginal exam and transvaginal ultrasound):

CA-125

Serum biomarker/multimodal panels such as ROMA (Risk of Ovarian Malignancy Algorithm), RMI (Risk of Malignancy Index), MIA (Multivariate Index Assay) may be used as an alternative to CA-125 alone

SYNOPSIS:

Although ovarian cancer has been described as “silent”, it is not uncommon for women with the disease to have abdominal symptoms. Persistent and progressive bloating, abdominal/pelvic pain, early satiety, appetite loss, urinary urgency, increased abdominal girth should be evaluated with a high index of suspicion for malignancy.

KEY POINTS:

When a pelvic mass has been identified on examination and imaging, consider referral to or consultation with a gynecologic oncologist when:

The patient is postmenopausal, the CA-125 is elevated, there is ascites, a nodular or fixed pelvic mass is present, or evidence of metastases

The patient is premenopausal, with a very elevated CA-125, ascites, or evidence of metastases

Staging for ovarian epithelial cancer is surgical and if malignancy is suspected or expected,

Peritoneal cytology should be obtained on entry into the abdomen

The adnexal mass should be removed intact

Liver, spleen, both diaphragms, and all peritoneal surfaces should be inspected and palpated

Traditional staging includes omentectomy, pelvic and para-aortic lymphadenectomy, peritoneal biopsies, removal of uterus and adnexa and all tumor nodules

The uterus and uninvolved ovary can be left in place if the malignancy is confined to one ovary and fertility is desired

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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